下肢深静脉血栓机械性血栓清除术循证医学证据及展望  

Evidence-based medicine evidence and prospect of percutaneous mechanical thrombectomy for deep venous thrombosis of lower limbs

作　　者：刘冰[1] 李哈莉[1] 韩鹏[1] LIU Bing;LI Ha-li;HAN Peng(Department of Vascular Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院血管外科,黑龙江哈尔滨150001

出　　处：《中国实用外科杂志》2021年第12期1356-1360,共5页Chinese Journal of Practical Surgery

基　　金：黑龙江省自然科学基金面上项目(No.H2017036)。

摘　　要：下肢深静脉血栓是临床中最为常见的血管疾病之一,急性期可引起肺栓塞(PE),威胁病人生命;慢性期可导致血栓后综合征(PTS),严重影响病人生活质量。对于下肢深静脉血栓的治疗,经历了早期的单纯药物治疗,到后来的接触性导管溶栓术(CDT),再到近年来开展和逐渐普及的经皮机械性血栓清除术(PMT)。目前的循证医学证据显示,PMT与CDT临床效果相当,而在血栓清除效率上PMT明显优于CDT;在有溶栓禁忌证和需要快速开通血运的特定条件下,PMT优于CDT;PMT可降低PTS的发生率及严重程度;此外PMT产生的出血等并发症发生率与CDT相比差异无统计学意义。可见,PMT在临床使用中安全、有效,可作为下肢深静脉血栓清除首选方式。PMT可单独使用,也可根据具体血栓清除效果给予后续的CDT治疗。Deep venous thrombosis of the lower extremities is one of the most common vascular diseases in clinical practice.Acute stage can cause pulmonary embolism(PE),which is life-threatening.Chronic stage can lead to post thrombotic syndrome(PTS),which seriously affects quality of life.At present,the treatment of thrombus is from single drug therapy in the early stage,to CDT later,and then to percutaneous mechanical thrombus removal(PMT),which has been developed and gradually popularized in recent years.However,PMT in the clinical application effect how,is uncertain,the author according to their own clinical experience with evidence-based medical evidence,including confirmation of subjective basis(clinical guidelines,expert consensus,expert advice,etc.)and objective confirmation basis(multi-center RCT,single-center study,mate analysis,etc.),and draw the conclusion.The clinical effect of PMT is similar to that of CDT,and PMT is significantly better than CDT in thrombus clearance efficiency.PMT is superior to CDT in the specific conditions of thrombolytic contraindication and rapid opening of blood supply.PMT can reduce the incidence and severity of PTS.In addition,bleeding and other complications caused by PMT are not significantly different from CDT.Therefore,PMT is considered safe and effective in clinical use,and can be used as the preferred method for the removal of lower limb deep vein thrombosis.It can be used alone,or subsequent CDT treatment can be given according to the specific thrombotic removal effect.

关 键 词：下肢深静脉血栓 机械性血栓清除 接触性导管溶栓 深静脉血栓后综合征 

分 类 号：R6[医药卫生—外科学]